甲状腺微小乳头状癌中央区淋巴结转移危险因素分析  

Analysing the risky factors of central lymph node metastasis in papillary thyroid microcarcinoma

作　　者：赵波 邱贝[1] 董晔尧 李红强[1] 张乐乐[1] 马润声 殷德涛[1] Zhao Bo;Qiu Bei;Dong Yeyao;Li Hongqiang;Zhang Lele;Ma Runsheng;Yin Detao(Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Key-Discipline Laboratory Clinical Medicine,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院甲状腺外科河南省高等学校临床医学重点学科开放实验室,450052

出　　处：《国际外科学杂志》2018年第12期832-836,共5页International Journal of Surgery

基　　金：国家自然科学基金(81372863);河南省高校科技创新团队项目(19IRTSTHN002).

摘　　要：目的探究影响甲状腺微小乳头状癌中央区淋巴结转移的因素,为临床上选择手术方式提供依据。方法回顾性分析2015年1月-2017年12月于郑州大学第一附属医院甲状腺外科行手术治疗的甲状腺微小乳头状癌患者536例,所有患者均行单侧甲状腺腺叶+峡部切除术+同侧中央区淋巴结清扫术。以是否发生中央区淋巴结转移分组,分别比较性别、年龄、癌灶数量、肿瘤突破包膜、BRAF^V600E基因突变、肿瘤最大直径在中央区淋巴结转移上的差异,运用t检验、x^2检验、单因素和多因素Logistic回归模型分析中央区转移的危险因素。结果转移组与非转移组在性别、年龄、BRAF^V600E基因突变、肿瘤最大直径差异有统计学意义(P<0.05),单因素回归分析显示:性别(P=0.046)、年龄(P<0.001)、肿瘤最大直径(P<0.001)及BRAF^V600E基因突变(P=0.016)与中央区淋巴结转移有关.多因素回归分析显示:肿瘤直径(P<0.001)、BRAF^V600E。基因突变(P=0.043)及年龄大小(P<0.001)为PTMC转移的独立危险因素。结论对于BRAF^V600E基因突变、年龄<45岁及肿瘤直径较大的甲状腺微小乳头状癌患者,发生转移的风险增加,手术时建议预防性清扫中央区淋巴结。Objective To evaluate the relationship between clinicopathological features and central lymph nodes metastasis in patients with papillary thyroid microcarcinoma (PTMC),and aim to provide an appropriate operation in clinic.Methods The clinical data of 536 patients undergoing surgical treatment in Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2017,who had pathologically confirmed popillary thyroid microcarcinoma (PTMC) were retrospectively analyzed.Thyroidectomy and isthmectomy with central compartment neck dissection were performed in all patients.The patients were divided into two groups according to whether there existed central lymph node metastasis,and compared the differences of gender,age,number of cancer lesions,tumor breakthrough envelope,BRAFV600E gene mutation,and tumor maximum diameter in the central lymph node metastasis,respectively,by t-test x2-test.Univariate logistic regression analysis and multivariate binary logistic regression analysis were conducted to find risky factors.Results There existed difference between two groups by completing the gender,age,the BRAFV600E gene mutation and maximal tumor diameter(P < 0.05).Univariate logistic regression analysis indicated that gender (P =0.046),age (P < 0.01),maximal tumor diameter(P <0.01) and the BRAFV600E gene mutation(P =0.016) were significant predictors for central lymph nodes metastasis.And multivariate binary logistic regression analysis revealed that the rate of lymph node metastasis significantly increased in cases of larger tumor diameter(P <0.01),BRAFV600E gene mutation(P =0.035) and ageing below 45 years old (P < 0.01).Conclusions The treatment for central lymph node metastasis of PTMC should be different considering elements including BRAF600E gene mutation prophylactic,ageing below 45 years old and larger tumor diameter.Therefore central lymphadenectomy should be performed when the primary lesion was resected.

关 键 词：淋巴结切除术 外科手术 卡方分布 甲状腺微小乳头状癌 BRAF^V600E基因 

分 类 号：R736.1[医药卫生—肿瘤]